scholarly journals Medical Vulnerability in America: How Does the Health System Respond?

2003 ◽  
Vol 40 (2) ◽  
pp. 198-209
Author(s):  
James R. Knickman ◽  
Kelly A. Hunt
Keyword(s):  
Health System ◽  
Access To Care ◽  
Chronically Ill ◽  
Market Change ◽  
Measuring Change ◽  
Actual Care ◽  
Market Changes

This study explores the hypothesis that market change affects the medically vulnerable more than the non-medically vulnerable. Analysis of data measuring change between 1997 and 1999 indicates that access to care eroded for both groups, but no evidence emerges to suggest that the changes were systematically worse for the medically vulnerable. Paradoxically, some measures of satisfaction with actual care received improved between 1997 and 1999 for both groups of people. Recent market changes do not seem to pose extra special threats to the medically vulnerable. However, our findings reinforce the need to better coordinate and integrate services for the medically vulnerable and chronically ill.

A view from abroad: a New Zealand perspective on the English NHS health reforms

2016 ◽  
Author(s):  
Robin Gauld
Keyword(s):  
Health Policy ◽  
New Zealand ◽  
Health System ◽  
Access To Care ◽  
Healthcare System ◽  
National Health ◽  
Universal Access ◽  
National Health System ◽  
High Income ◽  
Coalition Government

The English NHS is of significance among health policy observers around the globe for various reasons. The NHS is particularly noteworthy for the fact that, for many, it represents the high-income world’s best attempt to have built and maintained a ‘national’ health system with a focus on universal access to care that is free at point of service. The NHS has been in transition for several years. Many commentators have highlighted the role and influence of US market ideals in this transition, with various UK governments clearly pushing this agenda. However, is often useful to look to countries more closely comparable to England, such as New Zealand, for comparison with a view to improvement. This chapter takes such an approach in looking at the NHS from abroad. It draws upon the case of NZ which, in many ways, is very similar to England when it comes to health policy and the healthcare system. In doing so, it aims to provide a critique of the NHS reforms and demonstrate that there are alternatives to the policies and structures being pursued for the English NHS by the Coalition government.

scholarly journals How the ‘plates’ of a health system can shift, change and adjust during economic recessions. A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

2020 ◽  
Author(s):  
Giuliano Russo ◽  
Maria Luiza Levi Paim ◽  
Maria Teresa Seabra Soares de Britto e Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Ruth Helena de Souza Britto Ferreira de Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Health Systems ◽  
Low Income ◽  
Sao Paulo ◽  
São Paulo ◽  
Public And Private ◽  
Qualitative Interview Study ◽  
Economic Recessions ◽  
The Impact

Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

Market legitimation in countercultural market change

2021 ◽  
pp. 147059312110560
Author(s):  
Hwanho Choi ◽  
Bernard Burnes
Keyword(s):  
South Korea ◽  
Institutional Change ◽  
Institutional Logics ◽  
Institutional Work ◽  
Market Change ◽  
Market Experience ◽  
Using Data ◽  
Indie Music ◽  
Depth Interviews ◽  
Market Changes

Drawing on concepts of institutional work, legitimacy, and institutional logics, we investigate why countercultural markets experience institutional change and the actions institutional work market actors perform to inform institutional logics and ensure the legitimacy of countercultural markets. Although previous research suggests market changes and disruption, little attention has been paid to markets that originate from different institutional backgrounds, changes in the market experience in relation to its legitimization, and institutional work to attain legitimacy. The case of indie music in South Korea illustrates the evolution of a cultural market from the introduction of its ethos, the crisis caused by legitimacy pressures, and the transformation of the market. Using data gathered through in-depth interviews with indie labels and music consumers in South Korea, and archival sources, our research illuminates the source of market struggle and theorizes approaches that market actors perform to overcome the struggle.

Governing healthcare: the case of Universal Health Insurance – by competition

2017 ◽  
Author(s):  
Cliona Loughnane
Keyword(s):  
Health Insurance ◽  
Health System ◽  
Access To Care ◽  
Equal Access ◽  
Universal Health Insurance ◽  
Social State ◽  
The Social ◽  
Liberal Government ◽  
The Government ◽  
Universal Health

In 2011, the Government committed to the introduction of Universal Health Insurance (UHI) ‘with equal access to care for all’ by 2016 (Government of Ireland 2011: 2). This chapter explores how proposals to implement a system in which every member of the population would be expected to take out health insurance – and mooted by politicians as a way to end Ireland’s two-tier health system – exhibited particular characteristics of advanced liberal modes of governing.Specifically, drawing on Rose and Miller’s (1992) conceptualisation of the ‘aspirations’ of advanced liberal government – governing at a distance, the management of risk, engendering individuals to take responsibility through choice, and the fragmentation of the social state into multiple communities – this chapter demonstrates how while a political rhetoric may have stressed the significance of UHI as a basis for promoting solidarity and fairness, it is hard to avoid the conclusion that the policy would have represented a further shift towards the marketization of Irish healthcare.

scholarly journals Evaluation of Patient Satisfaction with Tuberculosis Services in Southern Nigeria

2015 ◽  
Vol 8 ◽  
pp. HSI.S27177 ◽  
Author(s):  
Ugochukwu U. Onyeonoro ◽  
Joseph N. Chukwu ◽  
Charles C. Nwafor ◽  
Anthony O. Meka ◽  
Babatunde I. Omotowo ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Health System ◽  
Access To Care ◽  
Care Facility ◽  
Related Factors ◽  
Staff Attitude ◽  
Patients Satisfaction ◽  
Multilinear Regression Analysis ◽  
Southern Nigeria ◽  
Adherence Counseling

Objective Knowing tuberculosis (TB) patients’ satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients’ satisfaction with TB services in southern Nigeria. Materials and Methods A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction. Test of association was used to study the relation between patient satisfaction scores and patient and health facility characteristics, while multilinear regression analysis was used to identify predictors of patient satisfaction. Results Highest satisfaction was reported for adherence counseling and access to care. Patient characteristics were associated with overall satisfaction, registration, adherence counseling, access to care, amenities, and staff attitude, while health system factors were associated with staff attitude, amenities, and health education. Predictors of satisfaction with TB services included gender, educational status, if tested for HIV, distance, payment for TB services, and level and type of health-care facility. Conclusion Patient- and health system–related factors were found to influence patient satisfaction and, hence, should be taken into consideration in TB service programing.

scholarly journals Assessing Early Access to Care and Child Survival during a Health System Strengthening Intervention in Mali: A Repeated Cross Sectional Survey

PLoS ONE ◽  
2013 ◽  
Vol 8 (12) ◽  
pp. e81304 ◽  
Author(s):  
Ari D. Johnson ◽  
Dana R. Thomson ◽  
Sidney Atwood ◽  
Ian Alley ◽  
Jessica L. Beckerman ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Child Survival ◽  
Health System Strengthening ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Early Access

scholarly journals Sisyphus and self-management: the chronic condition self-management paradox

2007 ◽  
Vol 31 (2) ◽  
pp. 184 ◽  
Author(s):  
Peter W Harvey ◽  
Barbara M Docherty
Keyword(s):  
Health Care ◽  
Health System ◽  
Chronic Condition ◽  
Chronically Ill ◽  
Medical Intervention ◽  
Self Management ◽  
Ageing Population ◽  
Economic Determinants ◽  
Ideological Perspective ◽  
Management Approaches

Chronic condition self-management is promoted internationally as not only a possible solution to the health problems of our increasingly chronically ill and ageing population, but as part of a new wave of consumer-led and volunteer-managed health care initiatives. Consumers are now indicating that they want to be more involved in the management of their lives and their health care options, while, especially in rural and smaller communities in Australia, a shortage of clinicians means that health care is rapidly changing. This emphasis on self-management raises crucial questions about where consumer action and control in health care should end and where clinical and medical intervention might begin. Hence, as in the case of Sisyphus and his rock, the self-management process is a difficult and demanding one that poses major challenges and loads for health system reformers and represents a struggle in which new difficulties are constantly emerging. This paper examines some implications of new self-management approaches to chronic illness from an ideological perspective and highlights key elements that underpin the effort to promote health-related lifestyle change. While peer-led self-management programs may assist certain individuals to live engaged and meaningful lives, the essential social and economic determinants of health and wellbeing mean that these programs are not the answer to our urgent need for major reform in the health care arena. Rather, selfmanagement, from an ideological perspective, represents a minor adjustment to the fabric of our health system.

scholarly journals Transsexuality in the streets of Campinas: borderline resistance movements towards a humanistic care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D S Komoda ◽  
J Justino ◽  
B Danny ◽  
S Suzy ◽  
S R Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Narrative Analysis ◽  
Life Experience ◽  
Case Reports ◽  
National Policy ◽  
Transgender People ◽  
Resistance Movements ◽  
Access To Health ◽  
Actual Care ◽  
Global And Local

Abstract According to WHO, transgender people are more likely to suffer from a broad range of health Issues high HIV prevalence, low access to health, discrimination, violence, rejection, unemployement, poverty, housing insecurity, and marginalisation. Structural macho-sexism is one of the main causes not only of violence, but also of lack of protective legislation and policy to this population. Developing research regarding transgender people's life experience in the streets and their pathways to healthcare is of major importance to achieve a more equitable society and public health system. This qualitative research is a chapter of the book “Experiências do Cuidado na Rua” (”Living Care in the Streets”). From the experience of offering care in downtown Campinas to people living in the streets, 2 case reports were selected. The narratives were collected in a field journal. Both participants were female transgenders living in the context of Brazil's Universal Health System. National policy and legislation were confronted with narrative analysis of the participants, to show the barriers to receiving proper and humanistic care. Some narratives show the clear violence suffered from law enforcement personnel: “We used to be beaten by the Police because we were prostituting ourselves”. Others show a transphobic moralistic context: “Last week a transexual had her heart torn here in Campinas, and a Saint image was put in her chest! I'm afraid to walk alone in the streets at night. “Yet others show a clear transphobic and problematic position from the now president Bolsonaro which reflects in transphobic sympathizers in hate speeches: “Nowadays [after presidential election] we hear in the streets 'let's send them to Bolsonaro!'”, as sending someone to the guillotine. The narratives show a clear need of global and local actions towards a more accepting society, and actions must be taken in a broad range of fields, such as human rights legislation, policy and surveillance. Key messages This research show the neglect for the transgender population and the lack of protective measures, which reflects in access to the health care system and actual care. A growth of discrimination and hate speeches directly related to the election of an extremist-right national administration has been observed.

Productivity efficiencies in Ukrainian polyclinics: lessons for health system transitions from differential responses to market changes

2008 ◽  
Vol 29 (2) ◽  
pp. 103-111 ◽  
Author(s):  
Patrick M. Bernet ◽  
Michael D. Rosko ◽  
Vivian G. Valdmanis ◽  
Anatoly Pilyavsky ◽  
William E. Aaronson
Keyword(s):  
Health System ◽  
Differential Responses ◽  
Market Changes

scholarly journals Variation matters and should be included in health care research for comparison of outcomes

2016 ◽  
Vol 18 (02) ◽  
pp. 183-187 ◽  
Author(s):  
Chris van Weel ◽  
Robyn Tamblyn ◽  
Deborah Turnbull
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Cultural Values ◽  
Health Research ◽  
Real Life ◽  
Health Care Research ◽  
Primary Health ◽  
Real Life Setting ◽  
Actual Care

Background Health care is provided under the conditions in which people live and under the rules and regulations of a prevailing health system. As a consequence, ‘local’ circumstances are an important determinant of the actual care that can be provided and its effects on the health of individuals and populations. This plays in particular, but not exclusively, a role in community-based primary health care. Although this is generally accepted, there is little insight in the impact of the setting and context in which health care is provided on the outcome of care. Aim This paper argues the case to use this natural variation within and between countries as an opportunity to be used as a form of natural experiment in health research. Arguments We argue that analysing and comparing outcomes across settings, that is comparative outcomes of interventions that have been performed under different health care conditions will improve the understanding of how the real-life setting in which health care is provided – including the health system, the socio-economic circumstances and prevailing cultural values – do determine outcome of care. Recommendations To facilitate comparison of research findings across health systems and different socio-economic and cultural contexts, we recommend a more detailed reporting of the conditions and circumstances under which health research has been performed. A set of core variables is proposed for studies in primary health care.

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